Table 3.

Themes and subthemes identified during the content analysis of clinicians open-ended responses regarding factors they would consider when determining whether to offer telehealth to a future client.

Main themes	Sub-Themes	Description	Quote	n (%)
Preferences	Young person willingness/ engagement	Preference of the young person and their willingness to engage with telehealth compared to in-person appointments, including a lack of appeal for telehealth due to discomfort with features (e.g. being on camera), difficulties with within-session engagement over telehealth, and telehealth increasing accessibility.	“[Young person's]’s strong preference for face-to-face [sessions].”"Most [are] comfortable engaging from their houses."	89 (97%)
	Clinician willingness	Preference of the clinician for telehealth compared to in-person appointments, including comfort with technology, additional administrative burdens such as difficulties setting up appointments, impacts such as fatigue from video conferencing platforms, the appeal of working remotely, and its consequences for work life balance and connection with a team environment.	“Very taxing [for] clinician[s] to be staring at a screen all day.”“The impact of online appointments on clinician job satisfaction and burnout”“Own preference for face-to-face”	20 (22%)
Client Risk & Safety	Complexity/acuity/risk level	Clinicians considered telehealth inappropriate for clients presenting with complex problems, such as psychosis, suicidality, recent history of hospitalisation, or those experiencing acute symptoms.	“Risk level (may not be suitable alterative for [young person] presenting with moderate-severe risk)”	81 (88%)
	Assessment & management of Risk	Assessing and managing challenging clinical scenarios including risk and ensuring client safety was considered more difficult through telehealth, particularly through a lack of visual observation needed for risk assessment and the ability to manage emotions or difficulties. Clients must have a safe home environment in which to participate in telehealth.	“Risk assessment reliant on engagement in-person e.g. physical appearance, affect – I would need additional training and supervision regarding synthesising available information in [a] video call.”	42 (46%)
Accessibility	Technology access & resources	Access to the required technology to run telehealth is critical, including a computer or smartphone with microphone, video, internet and/or data required to access telehealth sessions.	“If a young person doesn't have the necessary resources for telehealth (technology, privacy etc).”	54 (59%)
	Safe private space	Clients need access to a safe and private environment in the home in order to receive telehealth sessions and meaningfully engage in the therapeutic process. Shared living, homelessness, or limited space were clear barriers.	“Privacy / confidentiality; challenges for many young people in ensuring they have a safe, private space at home”	41 (45%)
	Facilitating engagement	Telehealth can increase service accessibility for some clients. Telehealth could assist young people overcome barriers related to physical location (rural/ out of catchment area), travel time, transport access, health issues, caregiving responsibilities, significant mental health symptoms, crises such as homelessness, and financial difficulties.	“If using telehealth would overcome barriers that would otherwise prevent a young person from engaging (e.g., inability to attend the centre due to not having access to transport, disability)”	31 (34%)
	Communication	Language and communication barriers, such as lack of interpreters for young people and families for whom English is an additional language, and symptoms related to psychosis and communication (e.g. thought disorder and dissociative symptoms).	“Barriers to clear communication”“Challenges integrating services provided in person e.g. interpreting”	5 (5%)
Therapeutic Process	Therapeutic risk/benefit	Therapeutic risk versus benefit needs to be determined, considering whether telehealth delivery may be counter-therapeutic due to enabling avoidance or inactivity. For some clients, telehealth may offer a graded step in receiving care.	"Therapeutic benefit to having clients attend face-to-face sessions e.g. needing to be organised and motivated enough to travel…and attend on time."	48 (52%)
	Therapeutic approach	Some therapeutic approaches are better suited to in-person therapy, e.g. trauma or cognitive analytic therapy, appeared linked to complexity of the therapy or ability to manage potentially negative responses.	“Needing specific therapeutic approach which is better offered in person (i.e.: trauma-focused work to ensure safety/containment)”	32 (35%)
	Therapeutic alliance	Therapeutic alliance may be more difficult to establish on telehealth with young people, particularly at early stages of building rapport, suggesting telehealth may be more appropriate following initial in-person sessions.	"I do not yet feel confident that I can establish rapport and engagement with young people…via telehealth in the same way that I can in-person."	27 (29%)